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Tuesday, September 26, 2006

Laparoscopic Gastric Banding

Dr. Pitamaha always says that there is too much aggression in the field of surgery today. Unfortunately, its always Dr. Broadwalk who proves him right!

Dr. Broadwalk has been transferred to another hospital but something in him made him want to do his first Lap. Gastric Banding (Surgery for morbid obesity where the stomach is banded to make you thin) at our hospital itself. So, he takes permission from the M.S., arranges and ICU bed, calls two surgeons from outside along with their private anaesthetists and sends us a 140 kg 5 ft 1" 40 something lady to be admitted in the ICU as a gift. Each of her legs were like two of mine combined and lets not even get started on the abdomen.

She was taken in the OT at 2 pm and the procedure started with the inroduction of the scope. Immediately, there were obvious problems.... They failed to take into account the weight of her liver which seemed to be large enough to cover everything else in the abdomen. As a result they were unable to get a correct plane to apply the gastric band and ended up struggling. When I say struggling I mean Dr. Boss Man, Dr. Lefty and Dr. Chopper (Head of dept of surgery) all came, saw, waited, saw some more, and left at varying intervals. Oh I might mention at this point that we are some 5 hours into the operation by now and all they've managed to do is tear a bit of the liver and make a small gap in the plane behind the stomach.

Now I don't mean to be cynical but Mom told me that they shouldn't try such a surgery in a setup as great as the B.M.C. and warned me of the problems that may arise. Sometimes the ego of a surgeon is all that matters and the two pvt docs were hell bent on proving everyone wrong. They failed!

The case was converted to an open surgery, took some 6 & 1/2 hours to do (routine 2 hrs) and was more traumatic for that 140 kg lady than walking with those two feet would ever be.

If I wasn't bound to protect identity I would have posted the photo of the lady but let me see if I can find one with just her legs...Just being a HUGE understatement, of course.

Oh another thing (sorry shanky) but the bariatric surgeon mentioned to Dr. Shanky that if he doesn't control his eating he would be next on the list!!

Thursday, September 21, 2006

An Emerg To Remember

Wednesday's are supposed to be light.
The OPD was light. We finished by 11.30 took rounds and settled in. I had the day shift for the casualty and it started.
Some corporator decided he knew whats best for one of the patients and sent him to the hosp with R hemiplegia (R side paralysis) Uncontrolled Diabetes and a nasty yellow dripping foot abscess/cellulitis with great toe gangrene. I have seen this yellow colour once before in my life and I was willing to bet this was Madura Mycosis / Actinomycosis. Since I knew my seniors would never allow a debridement with an uncontrolled blood sugar level, I advised him to go in for hyperbaric O2 therapy but the AMO intervened and had him admitted into the Medical Ward.
Well, this guy was bad and he died today with counts of 37,500 (too high). The clincher - When I gave the patient the option of hyperbaric he was only too willing to go and get it done at Kasturba (we don't have a hyperbaric chamber) but the AMO forced him to get admitted because he had a corporators letter and couldn't be turned away....never mind the well being of the patient.

The other thing was a perforation that came in in the evening. His timing was so great that just at that time Dr. Big Boss Man's patient collapsed in the ward and her relative panicked and called him directly. He lost it, I mean LOST it. He called Dr. Shanky and let him have it. I was sitting some 6 feet away and I could see Dr. Shanky replying but couldn't hear a word he said...After the call he was in a state of shock! To top it off he had also told him that he was sending another patient, active tuberculosis with a ? Perforation. Now everyone started to panic cause no one wants to see the Boss Man in a bad mood. He's viscious. We were all tracking progress, getting Xrays and putting tubes whereever possible.
When the X ray of the TB patient came we all almost fell over. He had lesions all over and we had to find his lung in there. We knew at that instant that this was trouble since no one would induce him there so we couldn't operate. We were told to sit on him and the other fellow.

Today morning we finally got the go ahead for the normal fellow and he was taken up in the afternoon. As soon as we finished him we get a call that the TB fellow is bad and getting worse. We tried reasoning with the anaesthetist but there was no way he was getting induced so we had to transfer him to Maike!(higher centre)
So, we've actually finished yesterday's emerg tonight at 10 and I'm exhausted beyond words...

Oh and somewhere in between all this we got another of the Boss' cases with a Hb of 3.3 Normal being 12 so he's weak beyond repair....sheesh and I have a double weekend coming up


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